ERCP ; Fake double orifice ampulla. скачать в хорошем качестве

ERCP ; Fake double orifice ampulla.

Male 54 yo, HIV infection with loss to antiretroviral treatment for over year with admission due to acute cholangitis, CT examination found diffuse GB and CBD wall thickening, mild dilated CBD 9mm, latest CD4 in this admission was 35(1.4%). ERCP was done with found 2 separate orifice at ampulla with bile run out from upper orifice, firstly, suspicious of bile duct and pancreatic duct completely separation opening. After a while of trial cannulation, evidence of connection between this 2 orifice seen by guide wire pass from upper to lower orifice, a fistula(choledochoduodenal fistula) was diagnosed with transpancreatic precut from lower orifice to upper fistula and deep bile duct cannulation reveal rather normal size CBD with short stricture at distal part at level of fistula. Additional EST with biopsy at ampulla stricture for exclusion of CMV papillitis and temporary 7fr stenting done.